阿托伐他汀和缬沙坦联合治疗对老年高血压患者左心室肥厚的逆转

目的:探讨阿托伐他汀和缬沙坦联合治疗对老年原发性高血压(EH)患者左心室肥厚(LVH)的逆转。方法:将135例伴LVH的老年EH患者随机分成缬沙坦组和缬沙坦加阿托伐他汀治疗组,设定血压达标值为收缩压(SBP)<140mmHg(1mmHg=0.133kPa)和舒张压(DBP)<90mmHg。2组患者分别口服起始剂量缬沙坦80mg/d和阿托伐他汀20mg/d加缬沙坦8Omg/d。随访周期为2周,若血压未能达标,则增加缬沙坦剂量至160mg/d。2组患者均口服氢氯噻嗪25mg/d。总疗程24周。检测治疗前后24h动态血压、左室质量指数(LVMI)。结果:2组治疗后LVMI分别较治疗前显著性降低(均P<0.01)。缬沙坦和阿托伐他汀治疗组治疗前后LVMI的降低幅度大于单独缬沙坦治疗组,差别均具有统计学意义(P<0.05)。结论:阿托伐他汀加缬沙坦联合治疗在逆转LVH和抑制心脏交感活性方面较缬沙坦单药治疗具有更加显著的作用,且这些作用独立于降压疗效之外。

Effects of Combined Treatment by Atorvastatin and Valsartan on Elderly Essential Hypertension Patients with left Ventricular Hypertrophy

Objective：To examine the effects of combined treatment by atorvastatin and valsartan on elderly essential hypertension（EH）patients with left ventricuiar hypertrophy（LVH）.Methods：A total of 135 elderly EH patients with LVH were divided randomly into two groups：valsartan group received valsartan 80mg per day,combined treatment group received atorvastatin 20mg and valsartan 80mg per day.All groups received dihydrochlorothiazide（DHCT） 25mg per day.If patients SBP still≥140 mmHg or DBP≥90 mmHg in the next two weeks,the dose of valsartan would be increased to twice as before until BP fell to the normal base level（SBP〈140mmHg and DBP〈90 mmHg）.The entire Treatment would last for 24 weeks.The 24-hour ambulatory blood pressure monitoring（ABPM）,left ventricular mass index（LVMI）and heart rate（HR）were examined before and after treatment for confirmming the efficacy of medication.Results：①The 24h SBP and 24h DBP of patients in two groups decreased significantly after treatment（all P〈0.01）,but there is not markedly difference in decreasing amplitude among the two groups（all P〉0.05）.②LVMI and HR of patients in two groups decreased significantly after treatment（all P〈0.01）and the decreasing amplitude of LVMI and HR of patients in combined treatment group were markedly higher than those of the atorvastatin group（all P〈0.05）.Conclusion：Combined treatment by atorvastatin and valsartan has more intensive effect on reversing LVH and inhibiting sympathetic activity,comparing with single valsartan drug treatment.Above effects are independent of blood pressure depressing.